Coleman M P, Estève J, Damiecki P, Arslan A, Renard H
IARC Sci Publ. 1993(121):1-806. doi: 10.3109/9780415874984-2.
Time trends in cancer risk have often been summarised by the observation that mortality from cancers associated with tobacco is increasing rapidly, while mortality from all other cancers is either stable or falling slightly, this slight decline being dominated by the decrease in mortality from stomach cancer. Until recently, and with some variation between the sexes, this simple summary of cancer mortality trends would have been broadly correct for a number of developed countries, and it remains useful in dismissing claims of an impending and unexplained epidemic of cancer, but it does not apply to all countries, and in some there have recently been striking changes in the trends in mortality from cancers associated with tobacco. Cancer mortality has been widely accepted as the most important measure of progress against cancer, since it reflects the impact of cancer on people, and has been considered less subject to distortion than incidence or survival, although this is open to question. Cancer mortality also reflects trends in incidence and survival to a greater or lesser extent. There has been controversy, however, over how cancer mortality trends should be interpreted, as well as over which measures should be used to assess progress in cancer control. An overall summary of trends in mortality from all cancers combined is of limited value in assessing progress against cancer, in any case. Increases in a common lethal cancer may numerically dominate overall mortality trends, perhaps concealing declines in less common or less lethal cancers, while opposite trends in cancers of the lung and stomach, for example, might lead to an overall impression that little has changed. Further, up to a third of cancer patients will not die of cancer, and cancer mortality statistics do not reflect their experience at all. Cancer mortality trends only indirectly reflect trends in the number of people who are diagnosed with cancer in a given year, and those who do die of cancer in a given year may have been diagnosed more than 3 years previously, even though many die earlier: this blurs the responsiveness of routine cancer mortality statistics as a measure of recent progress, and alternative measures have been proposed. Trends in competing risks of death, especially at higher ages, may also complicate the interpretation of cancer mortality trends. The chance of developing cancer, and in that event, the chances of surviving it, are of direct interest to individuals.(ABSTRACT TRUNCATED AT 400 WORDS)
与烟草相关的癌症死亡率迅速上升，而所有其他癌症的死亡率要么稳定，要么略有下降，这种轻微下降主要是由胃癌死亡率的下降所致。直到最近，尽管男女之间存在一些差异，但对于许多发达国家来说，这种对癌症死亡率趋势的简单总结在很大程度上是正确的，并且在驳斥即将出现且无法解释的癌症流行的说法时仍然有用，但它并不适用于所有国家，并且在一些国家，与烟草相关的癌症死亡率趋势最近发生了显著变化。癌症死亡率已被广泛认为是对抗癌症进展的最重要指标，因为它反映了癌症对人们的影响，并且被认为比发病率或生存率更不易受到扭曲，尽管这一点存在争议。癌症死亡率在一定程度上也反映了发病率和生存率的趋势。然而，对于如何解释癌症死亡率趋势以及应使用哪些指标来评估癌症控制进展存在争议。无论如何，所有癌症合并死亡率趋势的总体总结在评估对抗癌症的进展方面价值有限。一种常见致命癌症的增加在数字上可能主导总体死亡率趋势，可能掩盖了不太常见或不太致命癌症的下降，而例如肺癌和胃癌的相反趋势可能导致总体印象是几乎没有变化。此外，高达三分之一的癌症患者不会死于癌症，癌症死亡率统计数据根本不反映他们的经历。癌症死亡率趋势仅间接反映特定年份被诊断患有癌症的人数趋势，而那些在特定年份死于癌症的人可能在三年多以前就已被诊断，尽管许多人更早死亡：这模糊了常规癌症死亡率统计数据作为近期进展衡量指标的响应性，因此有人提出了替代指标。死亡竞争风险的趋势，尤其是在较高年龄段，也可能使癌症死亡率趋势的解释变得复杂。个体直接关心患癌的几率，以及在患癌情况下存活的几率。 （摘要截取自400字）
